Things to keep in mind while opting for a critical illness policy
Buying any health insurance policy requires you to carefully analyse the policy details to ensure that there are no hidden fees and chargers, and you get maximum coverage at reasonable premium. Given below are the key things to remember when opting for a critical illness policy:
Tax benefits under a critical illness insurance policy
The fact that critical illness insurance offers tax benefits is an additional advantage, and you can claim tax deductions against the premium paid under the relevant sections of the prevalent tax laws.
Importance of critical illness insurance in India
One of the most important benefits of this health insurance plan is the enhanced coverage. It covers a wide range of critical illnesses and helps the insured manage all associated healthcare expenses besides hospitalisation costs. A critical illness insurance plan also offers a lump-sum amount that helps individuals manage healthcare costs in a better way.
How critical illness insurance works?
Critical illness insurance, often referred to as critical illness cover, functions as a policy where the policyholder pays regular premiums to an insurance provider. In the unfortunate event that the insured individual is diagnosed with a predefined critical illness, a waiting period typically applies.
After this waiting period, the policy offers a tax-free lump-sum payout. This financial support can be utilised to cover medical expenses, debts, or any other financial obligations. The extent of coverage varies based on the specific critical illnesses listed in the policy.
Typically, once a successful claim is processed, the policy terminates, offering crucial financial protection alongside traditional health insurance.
Critical illness insurance plan vs Health insurance plan
Below is a comparison of critical illness insurance plans and health insurance plans:
Aspects
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Critical illness insurance
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Health insurance
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Purpose
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Provides a lump-sum payout upon diagnosis of specific critical illnesses, such as cancer or heart disease.
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Covers a broader range of medical expenses, including hospitalisation, doctor visits, and preventive care.
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Coverage
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Covers a limited number of critical illnesses specified in the policy, offering financial support during severe health crises.
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Offers comprehensive coverage for a wide range of medical expenses, including routine and emergency healthcare.
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Premium
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Lower in comparison to health insurance policies.
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Higher as it offers extensive coverage for healthcare needs.
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Pay-out
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One-time lump sum payment upon diagnosis of a covered critical illness.
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Reimburses actual medical expenses up to policy limits.
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Policy termination
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Terminates after a successful claim.
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Continues to provide coverage for other illnesses and medical expenses even after a claim is made
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Who should buy a critical illness insurance policy?
A critical illness insurance policy can be beneficial for the following individuals:
Inclusions of Critical Illness Insurance policy
Here are the standard inclusions under critical illness policy:
Critical illness health insurance mainly covers max up to 50 major critical illnesses. Some of these are coronary artery bypass surgery, stroke, kidney failure, major organ transplant, etc.
The critical illness cover amount varies depending upon the insurance provider.
You can benefit from critical illness insurance within 30 days of diagnosis or as mentioned in the terms and conditions of the critical illness insurance policy.
The insured gets the lump-sum amount as mentioned in the critical illness policy.
The critical illness insurance policy also covers annual health check-ups.
Exclusions of critical illness insurance policy
Here are the standard exclusions under the critical illness policy:
There is no compensation if a person dies within 30 days of diagnosis of critical illness or surgery.
Any critical illness developed due to smoking, tobacco, alcohol, or drug intake is not included in the policy.
The critical illness developed due to internal or external congenital disorder is not included in critical illness insurance.
Pregnancy or childbirth-related critical conditions are not covered under critical illness insurance.
Adventure sports injuries, self-harm, and war injuries are not included in the critical illness policy.
How to file a claim for critical illness policy?
Here are the complete process for the Claim Process for Critical Illness Insurance Policy:
Cashless claim
You get cashless treatment facility at the insurer’s network hospitals. Here you do not have to deal with any paperwork. The network hospital will take care of the entire claim process. You simply have to follow the below procedure.
Approach the network hospital with your policy details.
The hospital will verify your details and send a pre-authorisation form to the insurer.
The insurer will verify the pre-authorisation request and convey the policy coverage and other details to the hospital.
Planned hospitalisation
Insured members should intimate about admission at least 72 hours before.
In the case of emergency hospitalisation, the insured member or his representative should intimate such admission within 24 hours.
The insurer will send you or the network hospital a pre-authorisation letter. The pre-authorisation letter, ID card issued to you along with this policy, and any other information or documentation that the insurer has specified must be produced to the network hospital identified in the pre-authorisation letter at the time of your admission to the same.
If the procedure above is followed, you will not be required to directly pay for the medical expenses above the aggregate deductible in the network hospital.
Original bills and evidence of treatment in respect of the same shall be left with the network hospital.
Reimbursement claim
If the insurer denies pre-authorisation under the cashless claim procedure mentioned above in a critical illness insurance policy. Or if the treatment taken is in a hospital other than a network hospital or if you do not wish to avail of the cashless facility, then the following procedure must be followed:
You or someone claiming on your behalf must inform the insurer in writing immediately within 48 hours of hospitalisation and gather all the hospital documents.
In the event of the insured person’s death, someone claiming on their behalf must inform the insurer (in writing) immediately and send a copy of the post-mortem report (if any) within 30 days.
The insurer shall not indemnify you for any period of hospitalisation of fewer than 24 hours, except for day-care procedures.